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, <br />� <br />Date %� <br />Application For <br />PUBLIC WGRKS PEf�MIT <br />Print or Type Only <br />�,,,��.� w�,�.. ���,�,,, . 8�� � - <br />o�ao o„m • — <br />Pu�lm Warhe Fen s Z.Q, (y O <br />lotel fox <br />lessApN FeePe�d S <br />9e��ncnbue S�0•OD <br />��!��6 i� Phone <br />Applicanl Mailing Address �'�Y Zip <br />i <br />Describo Proposed Wcrk <br />/N�i/!�« �5 ic'��>c' Cl�ti'r�'r'7z••' ,7��'�v�`k' <br />w <br />Prolect Atldress (lf known) <br /><<� <br />AUach Inw (41 copies ol plans lor proposed work - Oravi to scale and note thr, lollowinq ac appGcable�. <br />• Property Linos <br />r Oulline and dlmensions ol ell exisling and <br />proposed struc�ures on ihe lot <br />• EKisting and proposed ulililiec <br />/i L <br />• Centerline ol Sireel <br />• Indicate North <br />• Show any proposed {�rading chanBes <br />• Show measurements <br />PERMII CON�ITIONS <br />1. All calls for Inspeclion shall be made 24 h�s in advance • phone 259•881 5. <br />2. All work sh:dl be perlormed in accordance wilh ihis permil nnd currect Gily ol Everetl Desi�n anJ Construction <br />Standerds and Specilicallons <br />3. Call Lowlion Underg�ounA Service 48 h�s. belore you diy TPLL FREE NUMBER i•B0�•424•S�J55. <br />`��,.--���1� 3-G-� <br />Approved lor Cans�y lion Dnte <br />(� Q.1 l�c 4�./L�u.�a S 3� <br />FINALINSPEG1iUN / \ <br />qpproved ais Consiruclad v <br />rrcrr�t �'UBLIC WORKS DEPARTMENT <br />� 3200 Cednr Streel <br />Ecerelt, lVA 98201 <br />phonc. 259-OE� 15 <br />Dalc <br />ACKNOWLEDG[MENT OF CONDRIONS <br />W <br />� <br />� <br />� <br />�w <br />_ / <br />O <br />a <br />The undersi9ned owner/applicanl hereby agrees to hold and sava harm� <br />�ess thr. City ol Everett Irom any nnn ^'I clnims lor damages, cosis. <br />eapenses. oi ceuses ol ection that mey arise becnuse of Inslallodon <br />anA meintenance ot Ihe Improvemont or other righbobwny use hereto <br />�pplied for end Iwlher agrees to ramovP seme upon nolice froin Ihe <br />Cit o replace pu ic property damaged iherehy. <br />,.,, r�, i. .3. it s y_— — <br />sig ture ol nnPlicA� at[i <br />RK AUTHORIZ[D BY THIS Pt:RM1T MUST BE STARTED WITHIN <br />i 180 DAVS OF DATE PERMIT IS ISSUED AND THEF[AFTER IS TO <br />BF DILIG[NTIY PURSUED TO GOMPLETION. THIS PERMIT MAY Bf <br />C�NCELL[D �Y THE GTY UPON ANY STOPPAGE OF WORK ON TNIS <br />PROJEGT OVER 90 D�VS DURATIOM <br />